Universidade Federal de Sergipe - UFS, Health Sciences Graduate Program, Aracaju, Sergipe, Brazil.
Universidade Federal de Sergipe - UFS, Department of Nursing, Sergipe, Brazil.
Braz Oral Res. 2020 Dec 18;34:e126. doi: 10.1590/1807-3107bor-2020.vol34.0126. eCollection 2020.
The coronavirus disease 2019 (COVID-19) outbreak has created unprecedent challenges for healthcare systems worldwide. Oncology services have been reorganized to decrease the risk of nosocomial acquisition of SARS-CoV-2, but changes in treatment pathways and follow-up cancer care can result in patients receiving suboptimal or delayed care. Herein, we describe a cross-sectional nested cohort study conducted to evaluate delays in care for patients with head and neck cancer (HNC) in post-treatment follow-up or palliative care during the COVID-19 pandemic in Northeast Brazil and its impact on health outcomes. Information was extracted from medical records and supplemented by telephone interviews. We compared the following health outcomes: self-perception of anxiety or sadness, fear of COVID-19 infection, cancer-related complications during social isolation, self-medication, diagnosis of COVID-19, and death between patients with and without delayed cancer care. The Mann-Whitney U test was used to compare distributions of continuous variables and the Fisher exact test was used for categorical variables. Thirty-one HNC patients were included in the study, and no case of confirmed SARS-CoV-2 was found. Delayed cancer care due to restriction in health services was reported in 58.1% of cases, and there was no report of telemedicine use during the COVID-19 outbreak. Cancer-related complications during the COVID-19 pandemic were described for most patients (67.7%) and included pain or discomfort, swelling, and dyspnea. Eight (25.8%) patients reported use of prescribed morphine or codeine to manage pain and six (19.4%) patients reported self-medication with over-the-counter (OTC) non-steroidal anti-inflammatory drugs (NSAIDs). We found an association between delayed HNC care and the use of self-medication (p = 0.028). This study indicated that patients with delayed HNC care during the COVID-19 outbreak are more likely to use self-medication with NSAIDs for pain management. Better strategies to follow HNC patients in socioeconomically disadvantaged communities need to be discussed and implemented.
2019 年冠状病毒病（COVID-19）疫情给全球医疗体系带来了前所未有的挑战。肿瘤学服务已进行了重组，以降低获得 SARS-CoV-2 的医院内感染的风险，但治疗途径和后续癌症护理的改变可能导致患者接受不理想或延迟的护理。在此，我们描述了一项在巴西东北部进行的横断面嵌套队列研究，该研究旨在评估 COVID-19 大流行期间接受头颈部癌症（HNC）治疗后随访或姑息治疗的患者的护理延迟情况及其对健康结果的影响。信息从病历中提取，并通过电话访谈进行补充。我们比较了以下健康结果：自我感知的焦虑或悲伤、对 COVID-19 感染的恐惧、社会隔离期间的癌症相关并发症、自我用药、COVID-19 诊断和死亡，比较对象为癌症护理延迟患者和非癌症护理延迟患者。使用 Mann-Whitney U 检验比较连续变量的分布，使用 Fisher 确切检验比较分类变量的分布。本研究纳入了 31 例 HNC 患者，未发现确诊的 SARS-CoV-2 病例。由于卫生服务受限而导致的癌症护理延迟在 58.1%的病例中报告，并且在 COVID-19 爆发期间没有报告使用远程医疗。大多数患者（67.7%）描述了 COVID-19 大流行期间的癌症相关并发症，包括疼痛或不适、肿胀和呼吸困难。8 例（25.8%）患者报告使用处方吗啡或可待因来管理疼痛，6 例（19.4%）患者报告使用非处方（OTC）非甾体抗炎药（NSAIDs）自我用药。我们发现 HNC 护理延迟与自我用药之间存在关联（p = 0.028）。本研究表明，在 COVID-19 爆发期间接受 HNC 护理延迟的患者更有可能使用 NSAIDs 自我用药来管理疼痛。需要讨论并实施更好的策略来随访社会经济弱势群体中的 HNC 患者。
